Earth Notes

10:13 pm

Wed August 22, 2007

More Hospitals Ban Routine VBACs

Audrey Creed is a full-time mom. On a recent sunny afternoon she breastfeeds her youngest while her two older boys play. All three of her children were born via C-section. Not by choice, Creed says.

CREED: I was just intensely disappointed and I had just really wanted the chance to try.

Creed had a last minute C-section with her first child because he wentinto distress. When she became pregnant with her second, she assumed she would be able to have a vaginal delivery. She was shocked to learn thatFlagstaff Medical Center didn't allow routine vaginal births after cesareans so she had to have a C section.

CREED: But what I really wanted was to be more present for the birth ofmy children to be involved some how. In a C section you're not involved at all. (fade out kids playing)

For most of the twentieth century the rule of thought was "once aC-section always a C-section." But in the early nineties emergingstudies showed V-BAC to be a safe option. So the National Institutes ofHealth and the American College of Obstetricians and Gynecologistsembraced V-BAC as a way to decrease the cesarean delivery rate that hadreached 25 percent.

O-B-G-Y-N Bruce Flamm is a clinical professor at the University ofCalifornia Irvine. He's researched VBACs extensively. He says while a C-section is major abdominal surgery, a VBAC also carries a risk.

FLAMM: The uterus will tear or rupture and that happens in about 1percent of the cases.

But for women who are not given any sort of drug to speed along the labor studies have shown there's only a point four percent chance of uterine rupture.

Initially V-BACs were only done at university hospitals where in housestaff was available at all times. But with the studies endorsing VBACs as an acceptable option Flamm says hospitals big and small started to allow V-BACs.

FLAMM: Then across the country as more people started doing VBACs they found that the uterine rupture rate was still about 1 percent. But in that 1 percent they started to see some very bad outcomes particularly for the baby. Somehospitals were not equipped to do a cesarean section very, very quicklyand that's why some hospitals said well we probably can't do VBACs anylonger.

Flagstaff Medical Center was one such hospital. Steve Lewis is the ChiefMedical Officer.

SFX: Crying baby LEWIS: This is a labor and delivery room. It's designed so that mom canlabor here can deliver the baby here... (fade out and under next graf)

Lewis says the hospital adopted its policy in 2005 after careful reviewof ACOG's guidelines, which call for the "immediate availability" of asurgical team.

LEWIS: We interpreted the guidelines strictly. And what that meant to us -because patient safety is the foremost concern -- was a dedicatedanesthesiologist and a dedicated obstetrician to that mom and that's abig deal. That means they're not doing something else. You can't havetwo moms in labor. They're dedicated to the mom who is laboring after aC section.

Lewis says they don't have the staff to do that for every VBAC so the policy was written - no routine VBACs.

For Audrey Creed though it's hard to understand. She says hospitals are there for emergencies after all.

CREED: It would be an emergency if a laboring woman who had a cesarean before had some sort of uterine rupture. I understand that's an emergency. I understand that's what the hospital's there for to handle emergencies and so in that respect the policy never made sense to me.

It's important to note that according to the federal Patient's Bill of Rights a woman can never be forced to have a cesarean. Every patient has the right to refuse any procedure or surgery. And a hospital cannot legally turn away a woman in labor.

There are women who have taken matters into their own hands. Some have chosen to drive to hospitals in Phoenix and Tucson that allow VBACs.

When Flagstaff OBGYN Beth Claxton became pregnant with her second child, she prepared herself for another C-section. But her doctor was willing to assist her in a VBAC.

So she asked an anesthesiologist friend to be in the delivery room and after a few hours of labor had a successful VBAC at Flagstaff Medical Center despite the hospital's policy.

CLAXTON: They weren't very happy about it. I think we all got our hands slapped.

The hospital told Claxton it wasn't fair to other patients. Claxton says the policy goes beyond quality of care. She believes it was driven by potential lawsuits.

CLAXTON: I feel really sad about it because I think everyone should be able to have the option. It's a pretty emotional topic for me. (crying) I think that the attorneys and everyone's afraid. It's taking the rights of women away from them.

In his studies of VBAC OBGYN Bruce Flamm says for women it all boils down to choice.

FLAMM: There were some women that strongly wanted cesareans in ourstudies and others that strongly did not want cesareans.

With hospitals having different policies that decision can often be difficult to make.